Originally published on The Biopsy.
“Are your ready to see this patient?” asked my attending.
This patient was a young mother-to-be, otherwise healthy with her first baby on the way. I had hardly conducted any prenatal checks myself nor led a gynecological exam. I was vaguely familiar with the questions I should ask and distantly comfortable with the physical exam maneuvers I was to perform.
I had done them before, once, in a time that seemed so far past. Mentally, I weighed the pros and cons of leading this appointment. The cons seemed to stack up.
“Are you ready?” echoed in my head.
The hollow spaces hissed back, “No.”
She withered into a sliver of a woman after I told her the news, “Stage 4 pulmonary adenocarcinoma. You have lung cancer that has spread throughout your body.”
“But I was so healthy?” You could see her life decisions replaying in her eyes through a lens of doubt, questioning everything.
“I am incredibly sorry. I honestly don’t know what to say.”
So I sat there while she delicately sobbed her regrets away. My hand reached out and held hers. I’d occasionally add prognostic words – chemo, palliative, radiation, family – but they just evaporated into the room’s dark cloud.
“I’m not ready for this,” her eyes pleaded with mine.
Having attended the University of California, Los Angeles for my first degree, I was initially drawn to Oregon Health & Science University for its reputation as one of the nation’s leading medical institutions. Upon the completion of my undergraduate career, I explored avenues in nursing-related research that worked mostly with underserved populations. OHSU’s outstanding research accomplishments pushed me to apply to its School of Nursing.
Being from Honolulu, Hawaii, I was initially hesitant to attend OHSU because I had never been so far removed from the comfort of family or friends (or the ocean). However, I ultimately chose OHSU because of my interview experience; I was especially impressed with the admission committee’s emphasis on working with the underserved. In my own life, I have undergone a range of meaningful experiences that have empowered me with the sensitivity to better understand the structural causes of health disparities. I have made it a priority to maintain this social awareness in a way that prioritises a balance between professional growth and personal health. OHSU wants to help its students maintain this balance. Students are given a plethora of resources that promote self-care and personal attentiveness. There are meditation rooms, student lounges stocked with coffee and tea, counseling services and even a light therapy room – all places where students can give themselves “personal attention.”
On a smaller scale, it is quite comforting to be able to walk through the halls of OHSU and be greeted with familiar faces and kind smiles; as an island girl, it makes my transition to the mainland not as intimidating and so much easier. The smaller university setting provides the opportunity for the cultivation of genuine relationships between the instructors and their students. Here, professors know your name, and questions are not considered a nuisance or a disruption during class time. OHSU gives students the opportunity to develop quality connections with clinical instructors and academic advisers because the small student-to-faculty ratio provides faculty with the space to be attentive to each student’s individual needs.
My feelings may be best encapsulated through a quote from the film, Lilo and Stitch. Lilo reminds us, “Ohana means family. Family means nobody gets left behind or forgotten.” In Hawaii, your ohana means everything, and I am so eternally grateful to be a part of the OHSU ohana, because boy, we sure do stick together!
(excerpted from the original blog post found at Times Higher Education)
I heard some variation of this phrase throughout my application process – during admissions lunches, from current students and from practicing providers. Prior to PA school I was usually a pretty independent person when it came to studying, and I took this to reflect on changing these habits to adopt a more group-study focus.
Six months into the program I found that this saying had a much broader meaning than I originally thought. I found that I had to rely on my family more than I could have even anticipated. For example, some nights before tests I’m not home until well after my wife and child are asleep. And my wife took a big risk in quitting her job and moving to a city where she had no connections. It was, and continues to be, difficult for me to ask them to make the sacrifices they do, but I know I could not make it here without them.
Beyond family, I found that I’ve needed my classmates more than I ever did in undergrad. By spending such an incredible amount of time with these people they became intimately involved in my life. Outside of studying, we commiserate, vent, blow off steam, explore Portland and have gotten to know each other well. Classmates regularly scheduled activities and get-togethers, especially after major hurdles in the program, and many turned out for them. The other day I thought about what an amazing job the admissions committee did in choosing our class. It really made all the difference in getting through these first few quarters.
For future PA students, or anyone in related programs, my advice would be to really get to know your classmates and spend time outside of class with them. It will be almost impossible to avoid doing this given the nature of these intense programs anyway, and it will make the time that much more enjoyable. If you do have family joining you through the experience, thank them regularly for the sacrifices they make to support you.
From what I can tell on social media, these lists of things are really popular to read. So, I give to you, the second year medical students, THREE TIPS FOR STEP 1 STUDYING:
- DO identify a person in medical school a year or two ahead of you to whom you can relate. For example, if you have a tendency toward anxiety, appreciate highly structured days, and tend to panic when plans don’t go exactly your way, I could totally be your person. I had a person like this who told me exactly what she did to prep for Step 1 and it was extremely helpful in creating my own plan. I identified with her when she spoke up at a peer-to-peer advising event, explaining that she spent Spring Break of her second year studying for Step 1, something that was entirely unnecessary. The connection was immediate.
- DO figure out what you need to succeed during study period. Then, block out what everyone else is saying that they are doing. Have confidence in your plan and stick to it! My person didn’t start studying during Spring Break because she thought she required this extra time to gain a knowledge advantage (I believe the popular term for this type of student is ‘gunner’), but because she knew that if she didn’t study she would spend her Spring Break stressing about not studying. It was for peace of mind. The daily exercise that one of your classmates may require may only add to your stress. Maybe what you need is a healthy pint of ice cream, or a family dinner, or a long walk with your dog. If I’m your person, you either need a brisk jog or a glass of wine. Stress. Evaporated.
- DO prepare for the feeling that you are failing Step 1. I hope this doesn’t trigger panic, as that is not my intention. On the contrary, I hope that you can acknowledge the feeling, take it in stride, and not let it affect your performance. I am happy with how I did on Step 1, but somehow I missed the memo about how terrible Step 1 makes you feel. I remember having a moment in the midst of the exam where I imagined what my life would be like if I simply went back to waiting tables. As a side note, I don’t recommend zoning out in the middle of Step 1, as the time crunch is real.
I hope that you enjoyed reading this list. Maybe it will get shared across all of Facebook and I’ll be a social media CELEBRITY. Hopefully it helps one or two of you MS2s during your study period and beyond. Also, I’m really not an anxious person. I just run a lot and drink wine occasionally.
StudentSpeak is pleased to present this guest post by Sylvia Peterson-Perry, MS3 who is dually-enrolled in the M.D. and MPH programs.
I first met John* while on my 3rd year inpatient internal medicine rotation at OHSU. He came in to the hospital for a swollen, painful left leg, was a current active IV heroin user, was homeless, and had no possessions but the dirty clothes he was wearing. He ate the hospital food more eagerly than any other patient I had during my 5 weeks on the wards, and was so excited when he was able to shower and change into hospital clothes. Not long into his hospital stay, John was found to have a huge intramuscular abscess, which we drained and treated with IV antibiotics – the medical management of his condition was relatively straightforward. However, the rest of John’s care was anything but – this hospitalization had been a wake-up call to him, and he was hoping to get in to treatment for his opiate addiction; he had no place to stay after we discharged him (with a still draining wound); he had no way for us to contact him for follow up; he didn’t even have clean or warm clothes. Most of the time, I think this would have been one of those cases that contribute to the depressing research on medical students losing their empathy and becoming more cynical during their 3rd year**. From my understanding, the usual situation for a patient like this would be a conversation with a social worker, who could maybe provide a few days in a motel and a list of shelters and places to go for donated food and clothes, encouragement (and maybe a list of resources) to stay off of heroin, and then discharging him essentially to the streets, where using again and being hospitalized again for the same condition is almost inevitable. This then contributes to burnout and associated victim-blaming thoughts and comments from providers that patients like this never change and aren’t worth putting effort into, because they will just go back out and use.
Fortunately, this was not the case with John.
StudentSpeak is pleased to present a guest post by radiation therapy student Annie Mae Jensen. This post is adapted from Annie’s remarks at the 2015 Donor Memorial Service, which honors the anatomical donors and their families who support OHSU students through a gift to the Body Donation Program.
Team Mildred Ruth, a.k.a. Ruthie! We’ve learned so much from you. Thank you for your beautiful gift! We may never know who you really were, but you will forever be our “First Patient.”
Dr. Cameron started the term with our entire class in a lecture hall, where he explained to us what a beautiful gift we had waiting in the next room. He cautioned that it was an amazing thing that these individuals wanted to support education even after death, however it might be difficult to meet our donors for the first time. He also cautioned that many students are affected more than they expect, and to extend respect to our donors, as well as our fellow classmates as they coped with meeting their first patient.
I was determined to not be “that girl” – I heard his words and I took it more as a challenge, blindly, to not let this meeting affect me. I didn’t want to appear weak in front of my peers, so I tried to suppress my emotions and empathy, which was, for me, very out of character.
We were assigned to inter-professional groups; each student in my group was a new face to me: one physician assistant student, two dental students, and myself, a future radiation therapist. My group was designated “7B.” I wanted to avoid appearing unprofessional to these new acquaintances, and it relieved me not to know the name or story of the donor I was assigned. We all stood together around our donor and introduced ourselves, and I jokingly said we were the Lucky Team #7! We all smiled and started to leave the room, but I felt compelled to stay behind for just a bit and whisper to my donor, “Thank you for your gift.”
Clinical rotations in PA school are all about learning. You see patients with conditions and diseases that you have read about during didactic year and learn how to manage them in the “real world.” You become more familiar with the inner workings of various clinical settings: emergency departments, operating rooms, outpatient clinics and inpatient wards. You learn just enough about insurance, billing and coding to make you teeter on the edge of sanity and be thankful that there are wonderful, capable people who manage those areas of clinical practice so it doesn’t fall on you to count bullets or verify ICD-10 codes for each diagnosis you make (though they can be amusing to peruse…my favorite? W61.62XD “Struck by a duck, subsequent encounter”). You master (well, try to master) the nuances of different electronic medical records and are amazed at how much easier holistic healthcare can be when all patient records are available for you to see.
The thing is, you end up learning about way more than just medicine. You learn about yourself and the kind of provider you want to become. You leave your comfort zone and embark on a 13 month adventure that takes you to clinics and hospitals throughout the Pacific Northwest. This journey has you living with classmates, honing your physical exam skills in urban and rural communities and meeting countless mentors, preceptors and patients. Along the way, you absorb all that you see and experience. Some of it you internalize, adding it to your ever-growing clinical practice toolbox. And some of it – a bad attitude, a confusing explanation, things that just don’t fit who you are – are thoughtfully discarded. Through this process, we begin shaping who we ultimately will become as healthcare providers.
“This is the true story of seven strangers picked to live in a duplex, work together and have their lives interlinked, to find out what happens when health students leave PDX…and start getting rural.”
Okay, so it’s not QUITE the salacious prologue to a hit MTV series, but it doesn’t make it any less valid for those involved. In truth, most of us (three PA students, three med students, one dental student – and one PharmD student who we didn’t live with but worked with) did not know each other before we started this adventure. The idea* seemed simple enough: bring OHSU students from myriad fields of medicine, assign them to a community project, and see what happens. And while there were many program goals to be met, it was what happened behind the scenes that really made a difference.
Week One was like the beginning of any other clinical rotation. Trying to get a feel of what your preceptor is like, what their expectations are, having moments of, “How did I miss that massive systolic murmur in a patient with aortic stenosis?!” And of course, getting to know a new town, voicing frustrations that they don’t have your favorite brand of hummus, and missing your boyfriend, your friends, and your creature comforts – #privilege.
But then came the weekend. You go crabbing on a boat, fraternize with other students, see some local events, and get a little taste of the culture surrounding you. You take a breather, put your game face on, and recognize that it’s not about you, it’s about the experience. And most importantly, it’s about being exposed to a different patient population, and that’s when everything started to sink in.
Physician Assistant programs are notoriously rigorous. As an incoming student, the years that lie ahead seem insurmountable. And then … before you know it you’ve hit the ground running and you’re well on your way. It’s now day 102 of what may very well be the most challenging 26 months of my life, but despite the challenges that PA school has thrown my way I couldn’t be happier. I’m not trying to minimize the sacrifices that my classmates and I make in order to become PAs, but at the end of a long week of classes punctuated by a challenging exam I feel lucky to be here and truly excited by what I am learning every day.
Until this point, much of my progress as a PA student has been measured by practical and written exams. Throughout the summer I was presented with a range of classes from Anatomy to Pathophysiology; each one helping to build a strong foundation of knowledge that will support me in my clinical medicine courses. Coursework was condensed into questions that challenged my ability to synthesize tremendous amounts of information and begin to apply it in a clinical context. I felt the growing pains of once again learning to be a student – this time in an entirely different type of academic environment. For the first time everything I was learning in school felt relevant and important. After all, one day someone’s life may depend on everything I was learning.
Fall quarter has now begun and there is a buzz in the air as we begin a highly anticipated mentoring program.
So it’s about 800 degrees centigrade and I’m wondering if I’ve lost my mind hiking Mt. Arashiyama in this heat. I turn and watch two children and their elderly grandparents skip gaily up the trail as if the incline and humidity are non-existent, and I curse their effervescence. I start gathering leaves and sticks to form a sort of make-shift grave site and mentally draft my goodbye note to my friends and family, because surely this is where I will die. How can people withstand this type of heat? Did you know that the back of your knees can sweat? Isn’t this the temperature at which meat starts to cook (and because I’m sweating so much does that mean I’ll start….poaching alive?)? I’m losing it.
In the distance I hear hoots and hollers, the call of one Japanese macaque to another, and I am reminded of what awaits me at the top: MONKEY PARK. “Do it for the monkeys!” I think to myself as I rise to my feet, “FOR THE MONKEYS!”
If I can give young graduate students any advice it’s this: APPLY FOR EVERYTHING. This philosophy is what led me to win a generous travel award through the Society for Neuroscience (SFN) that sent me to Japan to participate in the Japan Neuroscience Meeting. I got the news at around 7:00 a.m. after rolling over in bed to check my email on my cell phone.
If I can give young graduate students a second piece of advice it’s this: DO NOT RESPOND TO EMAILS AT 7A.M. ON YOUR CELL PHONE. I know this because instead of forwarding the email to my PI, I accidentally hit “reply” and sent the arbiter of the award an expletive ridden “OMG, I’M FREAKING OUT” style email. I’m a true beacon of professionalism.